Current opinion in pediatrics: pediatric lung transplantation in the 21 st century

This review provides a summary of the evolving landscape of pediatric lung transplantation highlighting current trends, short and long-term outcomes, ongoing challenges in posttransplant survival, and unique considerations in pediatric populations.

The annual volume of pediatric lung transplantation has declined over the past decade due to a decreased need among children with cystic fibrosis. Improvement in survival has paralleled advancements in bridge to transplant strategies, expanding what were once considered contraindications. Despite the ongoing shortage of donor organs, innovations in policy changes, surgical and immunologic strategies, and organ preservation technologies have expanded the donor lung pool. Chronic lung allograft dysfunction (CLAD) remains the primary limitation to long-term survival, with limited management strategies and emerging immunomodulatory therapies offering promise.

As survival in pediatric lung transplantation improves, emphasis should shift to long-term outcomes including quality of life and equitable care, development of effective CLAD prevention strategies and pediatric-specific guidelines to optimize long-term survival.